Provider Demographics
NPI:1699183756
Name:MOORE MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:MOORE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-896-4482
Mailing Address - Street 1:490 SAINT ANDREWS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-6578
Mailing Address - Country:US
Mailing Address - Phone:615-896-4482
Mailing Address - Fax:615-896-4472
Practice Address - Street 1:490 SAINT ANDREWS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6578
Practice Address - Country:US
Practice Address - Phone:615-896-4482
Practice Address - Fax:615-896-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7533363LF0000X
TN7885363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty